Taking The Giant Leap To A Cash Practice .. found on webpage: http://www.chiro.org/newDCs
By Phil Mancuso, D.C.
(Reprinted from Chiropractic Showcase Magazine, April, 1994)
"Pat, whadaya mean, the insurance checks aren't coming in like they used
to?" I asked in a panic. "Why, there's insurance equality, and the Wilk
case, and...and..."
Everything was so much simpler years ago: there wasn't much paperwork
and rigamarole to alter your healing consciousness. During the 80's,
with the arrival of major medical benefits, things were really cooking,
weren't they? I ran a family practice with about 90% of our patients on
assignment. I'm sure you know that story. But now it's the 90's and it's
HMO's PPO's Medicare, Managed Care! In these fast changing, uncertain
times, who can concentrate on running a practice?
I'm sure you've all heard the death knell of insurance benefits - "Doc,
my insurance ran out and I don't want to spend the money!" Or how
about,"You're not in my network." Ouch! That really hurts, doesn't it?
And this, many times from patients that have been coming in for years.
Have you noticed that the deductibles are getting more and more
outrageous, while smaller and smaller checks are taking longer and
longer to come in? If your patient volume and cash flow are heading
south, you're not alone. Instead of being held hostage by the insurance
companies, maybe it's time to take the giant leap to a cash practice.
The Secrets Of Practice Growth In These Troubling Times
It's now fashionable among the management 'gurus' to be promoting the
concept of switching to full fee cash practice. "But," you say, "how
will I be able to get all my patients to come in and plunk down cold
hard cash when they've been used to paying almost nothing for all these
years?" Oh, ye of little faith.
Remember, the early chiropractors didn't have insurance benefits and
most of them thrived in spite of all the organized medical opposition
and bad public relations. Many early D.C.'s had to keep moving their
offices so that spotters from the medical boards wouldn't arrest them
for practicing medicine without a license. I know it for a fact: my Dad
was one of those early Chiropractors. How would you have liked to try to
build a practice under those conditions? And what about public
relations? Chiropractors were rarely mentioned, except in derogatory
terms. In fact, until recently, one of the few movies that even
mentioned the word Chiropractor was made back in the McCarthy Era (the
early 50's for all you youngsters out there.) The Chiropractor (who
looked remarkably like B.J. Palmer) turned out to be a communist spy!
So Dad and all his cohorts made it in spite of all the adversity because
they embodied an exquisite faith, confidence and belief in Chiropractic.
Now many of you are in a panic because you don't know what the future
holds, and are looking for the solution to your dilemma?
Let me digress...
In 1987, we switched from assignment to full fee cash overnight! "It's
financial suicide!" my friends said. "Patients are spoiled and nobody's
going to want to pay!" they admonished. When we actually made the shift,
I felt like Neil Armstrong about to put his foot on the moon: "That's
one small step for man, one giant leap for mankind!" On Monday morning,
without fanfare or prior notice, simply, (and elegantly) switched. Now I
think I know how the Manhattan Project physicists felt when they were
about to detonate the first atomic bomb - we knew something monumental
was imminent, but weren't quite sure how it was all going to turn out.
We were able to go from a 90% assignment practice with a high overhead
needed for claims processing (read that chasing down our money,) to a
cash practice with a low overhead and a 98% collection rate!
To survive in the 90's, you need to take bold steps - the old stuff just
doesn't work any more! If you're one of those D.C's who charges $150 to
$200 a visit, this procedure may not be for you. If you're interested in
charging more earthly fees, then you can't help but prosper with full
fee cash practice now and into the future.
It's been my experience that one of the best ways to implement a cash
procedure is to have one person in the office responsible for all
financial arrangements with patients. As clinic director, I'm not even
allowed to make financial arrangements! We never hear, "Dr. Blank says I
only have to pay this much." or something similar.
All too often, confusion about payment with assigned benefits became a
stumbling block to much needed continued care or family care! We have
found that patients are much more compliant when they understand (and
agree to ) their financial obligations right from the get-go. Since we
instituted the one person rule at our office, our collection rate has
been between consistently between 95-98%! Compare that with the
'cooperation' you get from the insurance companies. In effect, our
personal 'hostage crisis' has been solved!
The transformation was so easy we couldn't believe it! The fear that
patients would balk at paying for services rendered was totally
unfounded. Oh, sure, we had the few who said "I'm going to Dr. Knuckles
down the street. He takes my insurance." We found that the core patients
we kept (95%) were glad to pay full fee for services rendered.
The Paralysis Of Analysis
So, are you just going to keep doing the same old thing the same old
way? Remember, insanity can be defined as doing the same thing over and
over and expecting different results. If you don't feel a compulsion and
abiding belief that Chiropractic care is as important as breathing,
drive a truck or do something else. Or, maybe you'll just hang on to the
blind hope that nothing is really changing and everything is going to be
O.K. Definitely don't try full fee cash practice. Stop agonizing over it
and just do it!
You too, can switch to a full fee cash practice if you firmly believe
that your service is worth the fee you charge. Although we approached
the transformation to cash with much consternation, we did it! You can
do it, too!
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›From Forbes Magazine:
"People are divided into three groups:
those who make things happen, those who watch things happen,
and those who ask, "What happened?"
Which one applies to you?"
Are you going to be one of the ones who makes things happen, or will you
be asking, "What happened?"
›
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NOTE: The switch to cash doesn't mean your staff will never have to
handle another insurance form ever again. To the contrary, in many cases
it will be imperative that your staff become even more efficient at
producing insurance forms. Here's how it works: when you accept
assignment, you wind up chasing insurance companies for payment . With
the change to full-fee cash practice your fee is paid by your patient,
and your staff is available (and well trained) to fill out their
insurance forms for them. It then becomes the responsibility of the
patient to chase down their payment from the insurance companies,
helping to keep your overhead and fees down!
The success of this system is a combination of a flexible payment
schedule and the ability to file insurance forms for our patients
quickly and efficiently! The devil is in the details!
Some of you may be afraid to make the switch, but, hey, wadda ya got to
lose?
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*IMPORTANT*
*Please check with individual state insurance and Chiropractic board
regulations before instituting any procedure in your office.